Coventry Health Care

[To assist us in bringing this matter to a close, you must give us a reason why you are rejecting the responseIf no reason is received your complaint will be closed Administratively Resolved] Complaint: [redacted] I am rejecting this response because: Regards, [redacted] Ok you probably notified my employer, but you didnt notify you personell offeringOn November a representative gave us a brochure indicating a free gym membership and one of the questions asked was about the gym memebrship I asked her and she said that this service will continued as previously How can a company like yours Coventry cannot fing the brochure? is that strangeSo you dont keep records (minutes, meetings)Youre intentions were to get as many mebers as possible because coventry was being purchase by another insurance carrierI can find the brochure for you as needed but I will so I can display your unethical practices and the lie behind itI will not stoped until you guys paid what I was offered I will look for the brochure Kind regards, [redacted]

[To assist us in bringing this m***er to a close, you must give us a reason why you are rejecting the responseIf no reason is received your complaint will be closed Administratively Resolved] Complaint: [redacted] I am rejecting this response because: I have submitted this information numerous times I ***ached copies to my complaint with the Revdex.comI am again ***aching the same files I printed this my online account and it show where Coventry took the money overdrew my account, on the next page it shows where the payment was taken on 03/03/ In addition, I have ***ached the fax confirmation where the information was sent on the 10th of March when the issue was first created In addition , I am unsure of whom [redacted] tried to contact on April 2, 2015; however, I can assure you it was not me or my number I can pull my records from [redacted] which will show all call logs for this date and I can assure you I have came from Coventry or [redacted] ***, nor was there a voicemail I now am of the mind to be compensated for the issues this has created for me I would like to receive interest on this amount of money It only took day to mess up my checking account, which is my business account, but it has taken or will take more than days to have this issue resolved I would like an additional, for my time and efforts to correct Coventry's mistake Regards, [redacted] ***

Dear *** [redacted] , Please see our response to complaint # [redacted] for [redacted] that was received by us on March 10, During our investigation, it was determined that Coventry received two separate enrollment files from the Health Insurance MarketplaceThe initial file was received December 19, It specified to enroll [redacted] onto a Coventry policy effective January 1, The second file was received January 2, It specified to enroll [redacted] onto a Coventry policy effective February 1, We did not receive a file advising us to terminate the initial policy that was created so both remained active Our Billing and Enrollment department was able to terminate the initial policy that was created as if it was never in force The policy termination was processed on March 11, The reconciliation for the Advanced Premium Tax Credits that Coventry receives based on our enrollment is processed once a month When the next reconciliation is sent to and received by the Marketplace, they will be responsible for sending [redacted] an updated [redacted] tax form We take customer complaints very seriously and appreciate you taking the time to contact us and giving us the opportunity to address [redacted] ’s concerns If there are any additional questions regarding this particular matter, please contact the Executive Resolution Team at [redacted] Regards, Chris B [redacted] Executive Resolution Team

"Times New Roman";">Dear [redacted] , Please see our response to complaint # [redacted] for [redacted] that was received by us on November 9, We are showing that [redacted] was covered by a plan named [redacted] through Coventry Health Care of Georgia beginning on January 11, The application for that plan was not done through the Marketplace The plan was no longer offered as of December 31, 2014, so the policy passively renewed to a new plan named Bronze $Copay HMO PD effective January 1, A termination request was not received for that policy and the recurring Electronic Funds Transfer (EFT) draft authorization had not been removed so the premium was drafted for January and February We regret that the renewal notice [redacted] was sent in did not mention that a termination request would need to be sent to prevent the passive renewal even if a new policy was applied for As [redacted] applied for a new policy through the Marketplace that became effective January 1, 2015, we were able to have the non-Marketplace policy terminated effective December 31, A refund of $was issued through the EFT process directly into the bank account from which the payments had been collectedThe approximate posting date for the deposit was November 13, At this time, we are showing that [redacted] ’s policy has a termination date of December 31, 2015, so as long as the premium is paid for December, her coverage will remain active through the end of the year Information was received from the Marketplace to enroll her on a different policy effective January 1, The first month’s premium payment will need to be made for that policy to complete the activation process We were not able to locate a call to Coventry such as the interaction [redacted] described regarding the November 30, 2015, termination date All termination requests need to be requested through the Marketplace so she may have been speaking with them If she wishes, we can assist in contacting the Marketplace to report the poor service she received We take customer complaints very seriously and appreciate you taking the time to contact us and giving us the opportunity to address [redacted] ’s concerns If there are any additional questions regarding this particular matter, please contact the Executive Resolution Team at [redacted] @***.com Regards, Chris B [redacted] Complaints and Appeals Consultant Executive Resolution Team

Dear *** [redacted] , Please see our response to complaint # [redacted] for [redacted] that was received by us on June 02, During our review, we found that [redacted] ***’s policy was created on March 08, 2014, per the file that was received from the Marketplace on March 07, 2014, with an effective date of April 01, The member was enrolled in a [redacted] Plan with a premium of $and an Advanced Premium Tax Credit (***) of $Starting June 01, 2014, the member was enrolled in a [redacted] Plan with a premium of $and an [redacted] of $ Starting January 01, 2015, the member was enrolled in a [redacted] Plan with a premium of $and an [redacted] of $Regarding [redacted] ***’s refund request, we are unable to issue the member a refund for the full month of MarchWe received a termination file from the Marketplace on March 04, 2015, with a termination date of March 19, We charged the member the full premium amount of March and issued a partial refund on March 20, 2015, in the amount of $ The member will need to contact the Marketplace to have the termination date changedOnce the Marketplace is able to change the termination date for the member, we can issue a refund based upon the termination date we receiveThe member can contact the Marketplace at ###-###-#### for further assistance I apologize for any difficulties this situation has caused [redacted] ***We take customer complaints very seriously and appreciate you taking the time to contact us and giving us the opportunity to address [redacted] ***’s concerns If there are any additional questions regarding this particular matter, please contact the Executive Resolution Team at [redacted] @***.com Regards, Julian C [redacted] Executive Resolution Team

Dear [redacted] , Please see our response to complaint # [redacted] for [redacted] that was received by us on May 01, Based on our review, [redacted] can disregard the past due letter he receivedThe letter was sent on April 11, 2015, and the policy wasn’t terminated until April 23, [redacted] is currently showing a $amount due for his policy [redacted] also requested a Certificate of Creditable Coverage (COCC)Unfortunately, these are no longer providedHowever, [redacted] may keep this response for his recordsI apologize for any inconvenience this situation has caused We take customer complaints very seriously and appreciate you taking the time to contact us and giving us the opportunity to address [redacted] ’s concerns If there are any additional questions regarding this particular matter, please contact the Executive Resolution Team at [redacted] or ###-###-#### Regards, Julian C [redacted] Executive Resolution Team

Dear [redacted] , Thank you for allowing us to address the concerns reported in complaint # [redacted] for [redacted] ***d that was received by us on November 26, 2014, regarding coverage for [redacted] Our Executive Resolution Team researched your concerns, and we would like to share the results of the review with you I would first like to provide the question and answer from the FAQ that [redacted] is referencing from the Department of Labor website at www.d [redacted] Q14: The HRSA Guidelines include a recommendation for all Food and Drug Administration (FDA) approved contraceptive methods, sterilization procedures, and patient education and counseling for all women with reproductive capacity, as prescribed by a health care providerMay a plan or issuer cover only oral contraceptives? NoThe HRSA Guidelines ensure women's access to the full range of FDA-approved contraceptive methods including, but not limited to, barrier methods, hormonal methods, and implanted devices, as well as patient education and counseling, as prescribed by a health care providerConsistent with PHS Act section and its implementing regulations, plans and issuers may use reasonable medical management techniques to control costs and promote efficient delivery of careFor example, plans may cover a generic drug without cost-sharing and impose cost-sharing for equivalent branded drugsHowever, in these instances, a plan or issuer must accommodate any individual for whom the generic drug (or a brand name drug) would be medically inappropriate, as determined by the individual's health care provider, by having a mechanism for waiving the otherwise applicable cost-sharing for the branded or non-preferred brand versionThis generic substitution approach is permissible for other pharmacy products, as long as the accommodation described above existsIf, however, a generic version is not available, or would not be medically appropriate for the patient as a prescribed brand name contraceptive method (as determined by the attending provider, in consultation with the patient), then a plan or issuer must provide coverage for the brand name drug in accordance with the requirements of the interim final regulations (that is, without cost-sharing, subject to reasonable medical management) This FAQ and the FDA publication titled “Birth Control: Medicines To Help You” list each of the different birth control methods We are following this guidance in ensuring that we have coverage options available under each of those listed methods The guidance does not require us to cover all unique forms of delivery under a given method Nuvaring is considered as a hormonal method, per the FDA publication While [redacted] is the only ring contraceptive available, there are other hormonal methods that are available at no cost share through our coverage of certain oral contraceptive pills and injectable contraceptives Consistent with the previously stated guidance, we allow exceptions for situations where a member’s physician has determined that the other methods for contraception available without cost share are medically inappropriateIn those cases, we would cover a drug or device that is standardly not covered, such as a brand name hormonal contraceptive, without cost share as well If [redacted] ***’s physician has determined that [redacted] is a medical necessity, they can contact us to request an authorization At that time, we would review the request and make a decision on whether or not an exception can be made to cover [redacted] with no cost share We take customer complaints very seriously and appreciate you taking the time to contact us and giving us the opportunity to address [redacted] ***’s concerns If you have any additional questions regarding this particular matter, please contact the Executive Resolution Team at [redacted] Regards, Chris B [redacted] Executive Resolution Team

[A default letter is provided here which indicates your acceptance of the business's response If you wish, you may update it before sending it.] Revdex.com: I have reviewed the response made by the business in reference to complaint ID [redacted] , and find that this resolution is satisfactory to me Regards, [redacted] ***

July 28, 2014Dear Sir or Madam:The Regulatory Compliance Department of Coventry Health Care of Missouri, Inc(“Coventry Health Care”) writes this letter in response to the consumer complaint filed by Crystal Rose regarding continuation of insuranceThe member states that she filled out a form to request cancellation of her policy however, a subsequent payment deduction still occurred.Research into this matter revealed that this member has an On-Exchange policy that was purchased through the MarketplaceAs a carrier, Coventry Health Care is not able to terminate coverage on this policyThe member must reach out to the Marketplace and initiate the termination record through themThe exact procedure would be for the member to log into the marketplace website that was used to enrollAccording to the Healthcare.gov website there will be a red button titled “Terminate/end all coverage”Once that is completed a file will be sent electronically from the Marketplace to the issuer (Coventry) to terminate the policy.Though it might seem to Coventry’s customers that it should be able to make changes to their coverage such as terminating coverage based on a member request without requiring direction from the Marketplace itself, Coventry is unable to make that changeThe structure of the ACA forces changes like this to occur only at the federal marketplace, and not at the health carrier, levelThe federal marketplace is working on their systems at this time, and they are erroneously sending customers to their carriers to make these changesThe customer must work through the federal marketplace in order to make this change on their end.The Exchange is the source of truth for enrollment and SEP determinationsConsumers must enroll through the Exchange, the Exchange sends an (standard EDI transmission) to Issuers that triggers enrollment actions and Issuers send back to the Exchange a confirmationIssuers are also notified by the Exchange of approved SEPs.Issuers may not make enrollment changes, including SEPS, outside the Exchange process.Therefore, in order for the member to cancel her policy, she must take the steps described above to do soOnce Coventry Health Care receives the Marketplaces’ data, it will terminate the member’s policy as she has requested.Coventry Health Care hopes this explanation provides the Revdex.com with the necessary information to complete the investigation of this matterIf you have any further questions or concerns, please feel free to contact me at ###-###-####, extension ***My fax number is ###-###-####, and my e-mail address is [email protected] truly yours,Neil M***, B.ARegulatory Compliance Analyst Coventry Health Care

Dear [redacted] , Thank you for allowing us to address the concerns reported in complaint # [redacted] for [redacted] that was received by us on November 21, 2014, regarding shopping cards that were offered through a recent television promotion Our Executive Resolution Team researched your concerns, and I would like to share the results of the review with you We were able to have the local Sales Director call and speak with **and [redacted] today regarding this matter The certificates are being mailed to allow them to receive their gift cards We take customer complaints very seriously and appreciate you taking the time to contact us and giving us the opportunity to address ** [redacted] ’s concerns If you have any additional questions regarding this particular matter, please contact the Executive Resolution Team at [redacted] Regards, Chris B [redacted] Executive Resolution Team

[To assist us in bringing this matter to a close, you must give us a reason why you are rejecting the responseIf no reason is received your complaint will be closed Administratively Resolved] Complaint: [redacted] I am rejecting this response because: I have still not received a letter that says I have a zero balance and that my account has been closed as of 3/31/Ironically I received my monthly bill despite Coventry claiming my policy has been canceled effective 3/31/When can I expect this letter? Regards, [redacted]

[A default letter is provided here which indicates your acceptance of the business's response If you wish, you may update it before sending it.] Revdex.com: I have reviewed the response made by the business in reference to complaint ID [redacted] , and find that this resolution is satisfactory to me I want to again thank the Revdex.com for helping to resolve this for meAs you can see, this was a failure in service and promises from Coventry Health care that resulted in me making numerous contacts to their local and corporate officesUltimately they did deliver the debit cards but it took too much effort from me Regards, [redacted]

April 21, Dear ** [redacted] :This letter is in response to your request for Coventry Health Care of Virginia, Incto respond to a complaint submitted by [redacted] regarding his medication [redacted] The member would like to be able to refill his prescription at the local pharmacy instead of doing a mail order.Coventry Health Care of Virginia, Incdoes not have a signed authorization release form from ** [redacted] indicating that the Revdex.com is representing him in this matterWe will respond directly to ***.Please contact me if you have any further questions involving this issueI can be reached at ###-###-####- [redacted] between the hours of 8:a.mand 5:p.mMonday through Friday.Sincerely,

[To assist us in bringing this matter to a close, you must give us a reason why you are rejecting the responseIf no reason is received your complaint will be closed Administratively Resolved] Complaint: [redacted] I am rejecting this response because: I called and left a message for my case manager last Friday and he has yet to return my phone call days laterThis is par for the course as his has happened for the last monthsEvery manager has said they would call me back and none doRegards, [redacted]

Hello, Thank you for your inquiry, regarding complaint # [redacted] for [redacted] Our Executive Resolution Team researched your concerns, and I would like to share the results of the review with you Upon receipt of the rejection we verified that we had the claims [redacted] is requesting we reprocess were completed today May 28, Please allow hours to reflect this change for your explanation of benefits onlineThe member is now responsible for a $copay In regards to the termination letter request, as stated in our previous response this is going to come from the Marketplace, not CoventryOnce we have on file, from the Marketplace, that this policy was terminated per the member's request, we will then be able to send a confirmation letter reflecting that a termination was made per the your request instead of for non-payment [redacted] needs to contact the Marketplace at ###-###-#### to cancel her policyWe as Coventry do not have the authority to cancel a policy that was purchased through the Marketplace We take customer complaints very seriously and appreciate you taking the time to contact us and giving us the opportunity to address [redacted] ’s concernsIf you have any additional questions regarding this particular matter, please contact the Executive Resolution Team at [redacted] Thank you, Ashley S Complaint and Appeal Consultant Executive Resolution Team

[To assist us in bringing this matter to a close, you must give us a reason why you are rejecting the responseIf no reason is received your complaint will be closed Administratively Resolved] Complaint: [redacted] I am rejecting this response because: I still have not gotten my refund company states they dont know how to refund my they owe me.I also having issues with marketplace working with them to submit my refund Regards, [redacted]

[A default letter is provided here which indicates your acceptance of the business's response If you wish, you may update it before sending it.] Revdex.com: THANK YOU SO VERY MUCH Revdex.com I have reviewed the response made by the business in reference to complaint ID [redacted] , and find that this resolution is satisfactory to me Regards, [redacted]

May 30, 2014Dear [redacted] This letter is in response to your request for Coventry Health Care of the Carolinas, Inc(“CHC Carolinas”) to respond to a complaint submitted by [redacted] regarding the request to terminate her policy as of February 28, and refund her premium payment in the amount of $The request was received by CHC Carolinas on May 15, 2014.CHC Carolinas does not have a signed authorization release form from [redacted] indicating that the Revdex.com is representing her in this matter; however we will contact [redacted] within three business daysWe will inform [redacted] that if she wishes to exercise her right to a grievance, CHC Carolinas will respond to the complaint in writing within calendar days of receipt of her request.Please contact me if you have any further questions involving this issueI can be reached at ###-###-####, extension [redacted] , Monday through Friday from 8:a.muntil 5:p.m.Sincerely,

October 1, Dear Sir or Madam: The Regulatory Compliance Department of Coventry Health Care of Missouri, Inc(“Coventry Health Care”) writes this letter in response to the consumer complaint transferred from the Missouri Revdex.com and filed by Seth Cobb regarding payment issues for his policyThis matter was also brought to the attention of the Missouri Department of Insurance.After research, the problem with the member’s payments was discovered and, by working with the member, the matter was resolvedA letter to this effect was forwarded to the Missouri Department of Insurance on August 4, Coventry Health Care hopes this explanation provides the Revdex.com with the necessary information to complete the investigation of this matterIf you have any further questions or concerns, please feel free to contact me at ###-###-####, extension ***My fax number is ###-###-####, and my e-mail address is [redacted] Very truly yours, Neil M Regulatory Compliance Analyst

November 17, Dear Sirs: This letter is in response to the aforementioned Case Number [redacted] regarding [redacted] ’s premium issuePlease find below the requested information.Our records indicate that [redacted] was unable to fill her prescriptions because her policy was reflecting as past due in the Express Scripts systemCurrently, [redacted] is reflecting as paid through December 31, 2014, in the Billing and Enrollment DepartmentThe Grace Period flag was placed on [redacted] ’s policy because the November premium was not received on timeOn November 14, 2014, an expedited Urgent Care request was submitted to Home Office to have the flag removed and reflecting the correct paid through date in all other systemsThe flag removal process can take 24-hoursOnce the flag is removed, [redacted] will be able to fill her prescriptionsBelow is a call history in chronological order which took place between [redacted] and Coventry.Call History: May 2, 2014: [redacted] called to make a paymentThe representative assisted her through the process and provided a confirmation number.June 27, 204: [redacted] called stating that her plan was supposed to become effective May 1, 2014.July 25, 2014: [redacted] called because the effective date of her policy is reflecting as April 1, 2014, when it should be May 1, The representative conferenced the Marketplace and the Marketplace confirmed that the effective date should be May 1, The representative submitted the request for review.July 31, 2014: [redacted] called to inquire about the status of her effective dateThe representative advised the request was submitted on July 25, 2014, and to allow 3-business days for the Reconciliation team to review.August 1, 2014: [redacted] called regarding the red flag on her policyThe representative advised the flag was placed due to a payment for April not being received [redacted] advised that she should not have the flag placed because she changed her effective date to May 1, 2014, and should not have a past due balanceThe representative submitted a request to have the flag removed from the policyAugust 4, 2014: [redacted] called regarding the red flag removalThe representative advised the flag was removed on August 4, 2014.If you have any questions, please contact me toll free at ###-###-####, or directly at ###-###-####, Monday through Friday from 8:am until 5:pmSincerely, Tracy T Complaint and Appeal Analyst